What makes a first-class psychiatrist? What are the traits that characterize the “ideal” psychiatrist? How does a good psychiatrist become great? There are many possible answers depending on who is asked.

In my view, after observing countless fellow psychiatrists over 3 decades in various settings, I have concluded there are 7 domains that determine the caliber of psychiatrists that we all aspire to be. It may be difficult to possess all the traits across all 7 domains but I propose it as an idealized model and a road map for the journey toward peak performance in our profession.

Domain I: Personal attributes

The ability to listen “actively” and observe “comprehensively”

Psychological mindedness and curiosity

Skillfully engages and develops therapeutic alliance with patients from the first encounter

Compassion and empathy, but pragmatic firmness about boundaries

Nonjudgmental stance and cognizance of one’s own limitations

Impeccable integrity and ethical conduct.

Domain II: Clinical mastery

Thorough familiarity with the principles of psychiatry and models of behavior and psychopathology

Rigor in applying a diagnostic label by employing the skills of a physician to check patients’ medical status to rule out general medical etiologies; monitors patients’ physical and mental health and refers as needed

Always well dressed and groomed with a professional appearance; projects the identity of being a physician; leadership of mental health teams

Involved in local, state, national, and international professional societies

Raises the profile of psychiatry within the medical field by networking with other physician organizations and participating in medical initiatives.

Domain IV: Organizational effectiveness

Leads balanced and well organized professional and personal lives

Smooth working relationship with individuals or agencies relevant to the patient’s treatment, including family members, medical and mental health professionals, hospital administrators, clinics, insurance companies, advocacy groups, and the legal system

Maintains an organized and complete medical record with measurement-based ratings of illness severity and side effects.

Domain V: Societal role

Establishes one’s self as a role model for those seeking advice and guidance not only for psychiatric disorders, but for various societal dilemmas and is an effective communicator

Feels comfortable in being a public figure in one’s community whose opinions are valued by laymen as well as other professionals

Serves as an ambassador for the profession by educating the public via various media outlets to erase misperceptions about mental illness or psychiatry, and to rebut and neutralize the occasional venomous assaults recklessly hurled by antipsychiatry cults.

Domain VI: Lifelong learning

Convinced of the need for continuous learning in an era of logarithmic growth of medical knowledge

Reads several articles a week from key journals about recent clinical and scientific advances and applies them to patients when appropriate

Recognizes the vast unmet needs in psychiatry, supports research, and understands that the research of today is the better treatment of tomorrow

Refers patients to clinical research protocols at the local academic institution and offers to collaborate as a rater or data collector

Takes the time to write up unusual clinical cases as a letter to the editor or case report and generate new clinical ideas

If not a full-time academic, volunteers to teach or supervise medical students or residents at the local medical school or teaching hospital.

Very few psychiatrists can excel at all 7 domains, but most meet the criteria for several of them. Every psychiatrist can move from good to great with a modicum of effort and motivation. If most of us do that, the caliber and standing of our psychiatric profession will continue to escalate.

An early refill request for psychostimulants for your college-age patient

﻿Mr. R, age 18, who has been taking amphetamine/dextroamphetamine, 10 mg/d, twice a day, for attention-deficit/hyperactivity disorder since he was age 10, comes to see you shortly after beginning college asking to refill earlier than usual. He says his symptoms are worse since beginning college and he is finding it difficult to focus in class and keep up with the heavy course work. He says he has been taking an extra 10 mg when he “needs the extra boost.” He asks for an early refill and increased dosage. How do you proceed?

Switch to an extended release formulation and increase the dosage to 30 mg/d

Switch to lisdexamfetamine, 30 mg/d

Prescribe amphetamine/dextroamphetamine, 10 mg, on an as-needed basis

Tell Mr. R to take his current prescription as prescribed and discuss the dangers of stimulant abuse. Reassess his symptoms at the next visit.